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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE lD/srG.COMMENTS Ownd-Buildo Dalmlim
<br />I hcrcby a0im und( p.n.lry of p..jury lnrt I h dnF fm it. contseloE Liffi. llw lor th. aollowin8 166 {*.r03 I 5 Bqin6
<br />lid kofesion Cod.): Any Cily o Cou9 which Equt* a pmn lo consrdci .ltcr, imp$vc, dddirh or rcpat dy .trucr@, Fior ro ils
<br />iisuac., llio Equis fi. +plicul for Euch p.mil io fil. 3 si8ncd ,lalnol ihal hc o. shc k lienscd puBudt to l,\. FDtilios of $.
<br />ConE dor's Lices.d L!* (Ch.tl., 9, CmnodnS ynh Sdlio. 7000 of Dvision 3 of tfi. BEinG {d Prcf6ioir Codd d tt{ h. or
<br />shc is rx.Bpr th.rcfffi sd thr bai! fd rh. rll.g.n .xdpdo Any violndon ol S@ti6 701 L5 by dy applicdr for c p.mn &bj.cn lh.
<br />appliml lo a civil Fn.lty ofnol horc lhq fivc hu.drcd dollas (1500).
<br />_1, a omq of lh. Fop.ny, or my @ploy6 wilh wa86 a rh.t solc @mpasdion, will do thc worL ed ttu structw i3 ool inrarrl.d
<br />or olIold l* 3n. ( S.c 70rL, Bui.6 sd Ptufoiidi Co<t : Tt! ConErld'i Licis. L!* doG nor spply to u oma of lhc pop.ny
<br />who buil& or improvd $.@n, -d who dG iuch *orr himcllor hdclaor6rcu8h his or hcrwn @ploys, proid.d $al such
<br />ihprcvcnoll e. iot iildrlcd or o0dcd for $lc. If, how.v.r, rh. buildinS or inprovcmor is sold widin on. yd of cohpl.tim, fic
<br />Omr-Builda will hN. th. brrdd of povin8 thd h. or th. not boild or imtrov. f6 $c purpGc of salc)
<br />_1, 6 oqcr of lll'c ,ropcny, m dclusiv.ly @.tmting vnb lcm.d .onrel6 rc coslrld L\. projer ( S*. 70a1, Bqii6, dd
<br />Prof6ion Cod!: Tlc Conr&tor'! Lian& Lre &'6 nor apply ro e ow.r ofprQdiy who blildr o inprcvd rha@n , md who
<br />cmtract! ao' such prcj.cr! wilh B coi!&to(, li.dsd puBudt to $. conr.lcto.s Lienr. law )
<br />_l I qmpt und.r S@tio .B & P C. fd rhis Eaon
<br />Dar.: Owna:
<br />WOR(!RS COMPENSATION Df, CLARATION
<br />I hcrcby affim undd pa.lty olpdjury o.. olrh. followin8 d.cldtioG
<br />_l h.y. ed will mainhi. . Cmific c ol Coiscil to S.lflnsdc ld worlc*' Mposalim, s pbvid.d fo. by Setio l?00 olrh.
<br />hbor co&, ld th. p.rf(x]tu& of lhc wod< for vhich th. pmn k iscd.
<br />_l havc ed will nainllin wsk.Et @mp.nsarion iNurdc., d r.qutcd by Serion 1700 of th€ Labor Codc, for lh. p.rlomucc ot rhe
<br />wort for vhi.h this Fmit i! issu.d M, wo*d'conp.tualio insurrc. cnirr ed policy numb.r,.
<br />PolicyNumb.!: Expi6
<br />(This s.crion nccd nol b.@Bpla.d if tn. pmn ii fd O.c hundrcd doll6 {1100 ) or 16,
<br />2^*,,,,ffi*,,i*rr"rhcp.rfom c. ofthc work fo *hich rhis i.frn
<br />lh. work6 comp.nsation las oicrifhir, od
<br />---o.b
<br />olthr Lrbor Cod., l shall, fonh*ith
<br />WARNtr{Gr f.ilurcto sccurc work6' @mr.nsalion cov.ros.ro crininsl p.nahia od civil
<br />fin6 up ro o.. hundrd $owad dolld {l100,000),in lddinon lo
<br />thr kbor Codc, inlcrBl &d .nom.yt fq
<br />a prcvidcd forlh.Sccrid 1076 of
<br />LICENSf, D CO]\TRACTORS DECLAr.{TION
<br />I hcEby amm unds p.n.lry or pdrury r!.t I n li@ns.d uidd prclisid of chspr.r 9
<br />lhc Baincs d Prof6ri@ C!d., {d my licoic is ii full forcc ed .ffel
<br />c
<br />I h@by rmm u.d.rpa.l9 ofF.july $ $@ b..o*rucrim lln.ting.X@.y for t'. pdfoffuc. of rhc wdt aq whi.h $is p.mit it
<br />iisu.d (sa 309r, Civ. C.).
<br />APPLICANT'S DECLARATION
<br />Dcmolirion PmirlAsb.(os Norifi catio r.dcBl R.sulations (Tirr. 40, Ia(6)
<br />_R.qut d Lcn.r ofNorificr,rio
<br />rh. i.dc..l rcgulaioN Esa-diDg 6b6t6
<br />cl'liry ln I hav. r.ad thi! applicarion dd gtal. thd ly wnh .1, Ciry dd Counry
<br />odin&cB dd Sur. L!w! r.l.rinS ro buildiDg
<br />lbovc reidd.d prcpcrty fq inrperioh purp@6.o
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torquing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />Meter Release FYg.
<br />I rtilJ ,I
<br />Rough I lnrr
<br />Service Meter
<br />FINAL 5..,MC U{S, a h.5s6,6S7
<br />Notes, Remarks, Etc.
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